The Council of Arab Ministers of Health endorsed on 13 March the Arab AIDS Strategy (2014-2020) during its 41st Ordinary Session held at the League of Arab States. The new Strategy is intended to guide the development of a coordinated and consensus-driven regional response to HIV.

In his opening remarks, Nabil El Araby, Secretary General of the League of Arab States, noted the importance of the landmark achievement. “I congratulate the efforts made to finalize the Arab AIDS Strategy which began with a Saudi initiative and was concluded with the support of UNAIDS, international organizations and concerned civil society organizations,” he said.

The new strategy comprises 10 goals which are aligned to the targets set in the 2011 United Nations General Assembly Political Declaration on HIV and AIDS while maintaining a broader vision for an AIDS-free generation beyond 2015. The 10 goals of the strategy include: To reduce HIV incidence among key populations at higher risk of infection by more than 50%; to eliminate new HIV infections among children; to increase HIV treatment coverage to 80%; to address stigma and discrimination; to improve AIDS financing; to address the special vulnerability of women and girls; and to review the policies around travel restrictions.

In a resolution of endorsement, the Ministers of Health requested that the League of Arab States and UNAIDS work closely to support and monitor the implementation of the strategy at country level. The League will provide seed funding to kick-start the implementation of the strategy through the organization of three high-level forums to discuss issues related to women leadership, media and religious leaders.

“Health is one of the basic and principle rights for each individual without discrimination on the basis of ethnicity, religion or political, economic or social affiliation,” said Adel Adawy, Egyptian Minister of Health and Population. “Raising the level of public health for the whole society is principle to achieving peace and security.”

UNAIDS worked closely with the League of Arab States, the Kingdom of Saudi Arabia and other member states to provide political and technical support to develop the strategy. A series of consultations, workshops and technical validation meetings were organized as well as high-level advocacy conducted at regional and global level for the endorsement of the strategy by the Council of Arab Ministers of Health.

“The endorsement of the Arab AIDS Strategy demonstrates a longstanding commitment and leadership to the AIDS response in Arab countries,” said Yamina Chakkar, UNAIDS Regional Director for the Middle East and North Africa, on behalf of UNAIDS Executive Director Michel Sidibé. “We thank the Council for making the Arab AIDS Strategy possible and for being an important ally in helping to shape how we will work towards ending the AIDS epidemic in the post-2015 era,” she added.

The rise in new HIV infections makes the Arab region home to one of the fastest growing HIV epidemics in the world. Between 2001 and 2012, the estimated number of people living with HIV in the League of Arab States member countries increased from 140 000 to 210 000. Since 2001, the number of people newly infected with HIV in the Arab countries has increased by more than 44%—from 18 000 to 26 000—and between 2001 and 2012 there was a 69% increase in AIDS-related deaths in this region.

Existing discriminatory laws, policies and practices as well as negative attitudes among health practitioners are some of the main obstacles impeding access to health services for many people.

This is one of the main conclusions coming out of a debate convened by UNAIDS on 11 March to explore how discriminatory barriers to health services affect different population groups including people living with HIV, undocumented migrants, transgender persons, and persons with disabilities.

For migrant people discrimination often starts at the point of departure, where pre-departure regulations can include mandatory testing for HIV, pregnancy and other health issues. To avoid these tests, migrants may opt for irregular channels of migration, thus becoming undocumented and unable to access health services.

For transgender persons, discrimination is embedded in the International Classification of Diseases, which considers transgender as a mental illness. In many countries, including more than 20 in Europe, transgender people are forced to go through sterilization before gender reassignment surgery in order to change their gender identity.

Speaking about the possible lack of understanding about transgender issues among the medical profession, Mauro Cabral from the Global Action for Trans Equality (GATE) stressed that, “ignorance cannot be an excuse anymore. Doctors must respect, and not judge, patients.”

Another common barrier identified was the perception among the general population in many countries that resources invested in health services are ‘wasted’ on such groups which many in society consider ‘less deserving’.

Monitoring and documenting discrimination was stressed as a strategy to generate evidence to address the problem. In this regard, the Stigma Index and Human Rights Count were highlighted as tools which have been successfully used to monitor discrimination against people living with HIV. For example, the Human Rights Count tool, revealed the practice of involuntary sterilizations of women living with HIV.

“When communities are given the space and opportunity to engage in human rights monitoring, the real obstacles of why people are not accessing health services can be identified and addressed,” said Chris Mallouris, community mobilization adviser at UNAIDS. “We must ensure that communities are at the centre of efforts to address discrimination. They must be there as equal partners,” he added.

The panel debate concluded with a sobering recognition of the long journey ahead to achieve zero discrimination. Participants recognized that action needs to be scaled up to overcome barriers to health services and that no one should be left behind if global health targets are to be achieved.

On the eve of International Women’s Day, UNAIDS, the Hotel InterContinental Genève and the Rudra-Béjart School of Dance came together to promote health equity and to ensure that women and girls living with HIV are not left behind.

The Rudra Béjart's School of Dance with the pianist Melodie Zhao presented an exclusive performance about gender equality and women’s empowerment created to commemorate the International Women’s Day (8 March). "For this event, I asked my staff to create choreographies that show the ‘men-women, harmony’ theme,” said Michel Gascard, Director of the Rudra Béjart's Dance School.

Throughout the evening the audience saw different pieces created by a variety of choreographers ranging from classical and improvised dances to songs in Russian—a reminder that the Women's Day date stems from the empowerment of the women in Russia in 1917.

“This event is an illustration of how the world of art, the private sector and the United Nations can join forces in support of women and girls living with HIV,” said Mariangela Simao, Chief of rights, gender and community mobilisation division at UNAIDS.  “If we want to achieve our vision of zero new HIV infections, zero AIDS-related deaths and zero discrimination we need many partners and friends from different sectors,” she added.

The celebration is one of the events planned for 2014 as part of the joint UNAIDS and the Hotel InterContinental Genève campaign ‘Where History is Made’—which aims to raise awareness and funds for the elimination of new HIV infections among children and keep mothers alive.

“Since launching our joint campaign in December, we at the InterContinental and many of our guests feel part of the global AIDS response”, said Jürgen Baumhoff, General Manager of the Hôtel InterContinental Geneva. “It has inspired us to be more actively involved with UNAIDS to achieve an AIDS-free generation.”

Gender inequality, including gender-based violence is a key risk factor for HIV among women. As a result, women and girls bear a disproportionate burden of the HIV epidemic. Globally, young women aged 15–24 are most vulnerable to HIV, with infection rates twice as high as in young men. According to UNAIDS, every hour 50 young women are newly infected with HIV and up to 45% of adolescent girls around the world report that their first sexual experience was forced. 

The Rudra Béjart's School of Dance is a private international free school sponsored by Sandoz, Béjart Ballet Lausanne, Loterie Romande, Fondation Leenaards, Béjart, Jaquet Droz.

Studies have shown that intimate partner violence can increase the risk of HIV infection by around 50% and that one in three women experience violence by their intimate partner during their lifetime. There is also evidence that violence, or the fear of violence undermines access to treatment, care and support services for women living with HIV.

In efforts to address the complex linkages between violence and HIV, in a statement, the United Nations Secretary-General Ban Ki-moon called on the world to do more, “We must take action to end violence against women and girls and ensure that they have the sexual and reproductive health and rights that they deserve. Violence has a drastic impact on the health of women and children and is inextricably linked to a higher prevalence of HIV. That is why I have made ending violence against women and girls a top priority for the United Nations.”

The Secretary-General’s call was amplified at the high-level panel Linking HIV, gender equality and sexual and reproductive health and rights as part of the Every Women Every Child initiative, and the post-2015 social justice agenda organized by UNAIDS during the 58th Commission on the Status of Women held in New York. “Not only is violence against women an extreme human rights violation, it also makes women more vulnerable to HIV infection,” said Michel Sidibé, Executive Director of UNAIDS. “Post-2015 is the opportunity to ensure all women and girls reach their full potential, without the threat of violence, risk of HIV infection and violation of their sexual and reproductive rights.”

The event, chaired jointly by Mr Sidibé and the Executive Director of UN Women Phumzile Mlambo-Ngcuka, encouraged dialogue around the critical need for women-centred efforts to end the AIDS epidemic; the advancement of sexual and reproductive health and rights for women; gender equality and women’s empowerment; and zero tolerance for gender-based violence. “The single most important strategy in dealing with HIV is empowering women and protecting their rights,” said Ms Mlambo-Ngcuka.

Panellists included HRH the Crown Princess Mary of Denmark, Ministers of Gender Equality from Ghana, Malawi, Brazil and a representative for young women living with and affected by HIV from Algeria. "In my region, discrimination is a societal phenomenon. We must continue to act to eliminate discrimination—it’s the key to the end of the AIDS epidemic,” said Fatima Bendida, El Hayet Network of People Living with HIV, Algeria.

The panellists also elaborated on the importance of addressing stigma and discrimination. They stressed the need to end violence against women for their own health, as well as to prevent new HIV infections. They also emphasized the particular focus needed on young women and girls to ensure they have access to comprehensive sexuality education that all women living with HIV have access to treatment, care and support, within a rights-based and social justice framework.

“It is essential that we achieve universal access to integrated sexual and reproductive health information, education and services, fully addressing HIV, based on gender equality and with zero-tolerance for gender-based violence,” said HRH Crown Princess Mary of Denmark, Patron of UNFPA and Member of the High Level Task Force for the International Conference on Population and Development

The panellists also highlighted poverty as a driver of HIV and sexual and reproductive ill-health and recognised equity in access to services as a key focus for development for women. They also emphasized the continued need to secure funding for the most marginalized in societies.

Ms Nancy Mahon, Executive Director of the M·A·C AIDS Fund moderated the event at which Mr Sidibé launched a UNAIDS Advocacy Brief: Unite with women unite against violence and HIV. The brief outlines five core reasons to prevent violence against women; violence against women is a human rights violation; women who experience violence are more likely to acquire HIV; women living with HIV are more likely to be subjected to violence; women most vulnerable to HIV are also most vulnerable to violence; and that violence undermines the HIV response by creating a barrier to accessing services.

The discussions at the panel event were an important milestone in the ongoing post-2015 debate, underlining the central role women living with HIV need to play in the discussions around the post-2015 debate.

The United Nations Secretary-General Ban Ki-moon met together with his team of United Nations Special Envoys on HIV/AIDS to discuss their strategic directions for the year ahead. UNAIDS Executive Director Michel Sidibé also participated in the meeting that took place on 10th March 2014  at the United Nations Headquarters in New York.

Welcoming his second meeting with the Special Envoys on HIV/AIDS since their appointment in 2012, the Secretary-General thanked them for their continued commitment and well-coordinated leadership and advocacy. Mr Ban said, “I commend you all for your excellent work in 2013 and am very pleased to learn that you are working closely with other Special Envoys, Special Representatives and Rapporteurs to advocate for and create synergies between your work. I am also happy to learn that you have worked closely with UNAIDS to develop specific strategic directions for 2014.” Mr Ban also welcomed the latest member of the team, Speciosa Wandira-Kazibwe.

“They are a dedicated and cohesive team and have been instrumental in advancing efforts to achieve the Millennium Development Goals,” said Michel Sidibé Executive Director of UNAIDS. “They also greatly support the Secretary-General and his call for a life of dignity for all and leaving no one behind.”

The Special Envoys on HIV/AIDS are formed by Speciosa Wandira-Kazibwe, Special Envoy for Africa; Michel Kazatchkine, Special Envoy for Eastern Europe and Central Asia; J.V.R. Prasada Rao, Special Envoy for Asia and the Pacific; and Edward Greene, Special Envoy for the Caribbean.

“We have an effective team with great coherence, and a deep understanding of regional specificities and global issues, and are able to work across areas of development beyond HIV,” Mr Ban added.

Their main areas of work are prioritizing to ensure the prominence of HIV in thematic areas are on drug policy, human rights, stigma and discrimination and the empowerment of women and girls.

The First Lady of Kenya, Margaret Kenyatta, participated on 9 March in the First Lady’s half marathon to raise awareness and resources for the ‘Beyond Zero’ campaign—an initiative to stop new HIV infections among children and improve the lives of mothers.

More than 30 000 participants including cabinet secretaries, members of the parliament, governors and their spouses, professional athletes, diplomatic corps and United Nations representatives took part in the 21-kilometre run in Nairobi, Kenya.

The First Lady congratulated the participants for their commitment to ending new HIV infections among children and keeping their mothers alive. “Today we ran to make sure we have an HIV-free generation in this country,” said Ms Kenyatta.

The funds raised during the half marathon will be used to scale up maternal and child health services, including purchasing of mobile clinics for the 47 counties throughout Kenya.

Receiving the First Lady at the finish line was the President of Kenya, Uhuru Kenyatta, who stressed the government’s full support for the initiative. “We want to ensure that we bring about a complete end to maternal deaths and to infant mortality as a result of children and mothers being unable to access proper care,” said President Kenyatta.

Since its launch in January 2014, the First Lady’s ‘Beyond Zero’ campaign and its Foundation have raised more than US$ 1 million during several events. For example, ahead of the marathon, the First Lady hosted a fund-raising breakfast at the statehouse with approximately 20 private sector companies where she unveiled the first of the 47 mobile clinics. On 13 April, the First Lady will participate in the London Marathon to raise visibility at a global level and mobilise additional resources for the campaign.

According to the 2013 estimates and projections from the government of Kenya, an estimated 9 400 babies were born with HIV in the country in 2013. HIV-related complications accounted for 15% of all deaths among children under the age of 5 in the same year.

James Macharia, the Cabinet Secretary in the Ministry of Health, said that it was unacceptable that 15 mothers and 270 children below 5 years die every day in Kenya largely from preventable causes. He congratulated the ‘Beyond Zero’ campaign and Foundation for making meaningful contributions in advancing maternal and child health in the country.

The annual Conference on Retroviruses and Opportunistic Infections (CROI) was held in Boston, US from 3-6 March 2014. Every year CROI provides an opportunity for researchers from around the world to come together and share the latest developments in HIV research and development. Several interesting areas of research which were presented at this year’s conference and UNAIDS spoke to Professor Salim S. Abdool Karim, Director of the Centre for the AIDS Programme of Research in South Africa and Chair of UNAIDS Scientific Expert Panel for an overview of the main highlights in HIV prevention, treatment and cure research. 

Q. Professor Karim, we heard of many exciting developments coming out of this year’s conference what did you see as the main advances in HIV prevention research?

A. The conference hosted a range of great presentations on AIDS treatment, prevention and cure. There was a strong theme on HIV prevention at this year’s CROI, focusing on how to improve effectiveness of antiretroviral (ARV) pre-exposure prophylaxis (PrEP). Studies over the last 3 years have provided enough evidence to demonstrate that antiretroviral drugs like tenofovir are effective. However, the ARVs being used for PrEP not taken as prescribed. At this year’s CROI, we saw a concerted move to find formulations that would have better adherence. To this end, a study of GSK-744LA, a long acting injectable which could transform PrEP from daily pill-taking to 3 monthly injections, showed good protection in monkeys. Another strategy to improve adherence is the development of a new vaginal ring, which has both the contraceptive and anti-HIV properties.  

Q. There was also much talk about cure for HIV—what was your take on that?  

A. The Mississippi baby is now just over 3 years old and has been off ARVs for more than 2 years but remains negative on the highly sensitive ELISA and PCR tests, strengthening the evidence that this child may be cured. The second child presented at the meeting is a 9 month baby who was thought to be cured. Unfortunately, it is not a possible to determine whether this child is indeed cured because the child is still on ARVs and it is not possible to determine if negative HIV tests are due to temporary viral suppression or to viral eradication. 

Q. Vaccine development also seems to be advancing—what do you see as the next major step in vaccine research? 

A. In vaccine science, several broadly neutralising antibodies have been identified and some have even been shown to be effective in preventing, treating or curing infection in monkeys.  The next step is to assess what effect these antibodies would have in the human body. 

Q. Is there anything else in the pipeline we should look out for? 

A. Yes, I am very impressed in the findings of gene modification approaches to treating HIV. I think this new technology has great potential.

It only takes a minute with the new Coordinator for the Asia Pacific Transgender Network (APTN), Natt Kraipet to see her determination and drive for bringing issues of transgender rights and health to the forefront in the region.

“This is an important time for transgender people to be in the spotlight. We are too often invisible within societies and especially within health settings and yet we face significant rights and health challenges—including high risk of HIV infection,” said Ms Kraipet.

From 18-20 February, APTN brought together community delegates and experts from eleven countries for a regional community consultation on transgender issues to Bangkok, Thailand in partnership with the Being LGBT in Asia regional initiative and the Asia and the Pacific regional offices of UNDP, UNAIDS, UN Women, WHO and USAID.

Featuring participation from China, Hong Kong, India, Indonesia, Japan, Nepal, New Zealand, Philippines, Singapore, Thailand and Tonga, the consultation aimed to develop a set of steps and actions that APTN could take with partners, to address and prioritize specific human rights and health needs of transgender women and men.

“Much more evidence and knowledge is needed to be able to ensure services and programmes are reaching transgender people most effectively. That’s why we need to be included in public fora where we can highlight challenges and solutions,” Kraipet said.

Research and data on HIV risk and prevalence among transgender people is limited regionally, but some studies have found that transgender women are 50 times more likely to acquire HIV than adult males and females of reproductive age in the general population[1]. Examples of available national surveillance data in some countries in Asia and the Pacific indicate high HIV prevalence among transgender women in cities, for example: 30% in Jakarta, Indonesia, 23% in Port Moresby, Papua New Guinea, 18% in Maharashtra, India and over 10% in Bangkok, Chiang Mai and Phuket in Thailand.

However, focused programmes and initiatives for transgender people are largely lacking in national responses to HIV. And where they do exist, HIV prevention efforts are estimated to reach less than half of the transgender people who need the services.

Critical obstacles to progress

A central focus of the community consultation examined how health and social systems are often not adapted to the realities and needs of the community, particularly in resource-poor settings. Many transgender women and men report lack of technical knowledge among health personnel to advise or deal with transgender issues such as information on hormones, transition operations, psycho-social support, side-effects and if and how antiretroviral treatment can be combined with treatment linked to transgender transition.

“Absence of experts in health services in low-resource areas can lead transgender people ‘underground’ to undertake transition operations and hormone treatment within non-regulated settings—which in turn can lead to greater health complications and increase vulnerability to HIV,” said Steve Kraus, Director of UNAIDS Asia and the Pacific.

Issues such as lack of transgender-specific data, and punitive legal and policy environments were also highlighted as critical obstacles keeping transgender people from accessing health and HIV services.

Signs of success

A number of legal developments and programmes in Asia and the Pacific are showing encouraging signs of progress. In Bangladesh, Nepal and Pakistan several rulings have been made and/or legislation introduced which recognize transgender status for identification and paves the way for transgender people to access social and health rights. In Thailand, transgender identity is increasingly taken into consideration within work and education settings.

The strengthening of APTN and fellow organizations in the region also provides important opportunities. APTN’s efforts have been buoyed with new funding received from the Robert Carr Fund which was secured with support from UNAIDS Asia and the Pacific.

“We want APTN to be a real platform for transgender people; to be a concrete organization that promotes diversity and helps first at the community level,” Ms Kraipet explains. “I am determined that we will see important progress for transgender people and on HIV issues in our region over the next years,” she said.